A comparative analysis of alcohol in fatal and nonfatal bicycling injuries

The Prevalence of "Drinking and Biking" and Associated Risk Factors: The Korea National Health and Nutrition Examination Survey

With the steady rise of health and environmental awareness, the number of bicyclists is increasing. However, there are few epidemiologic studies on bicycling under the influence (BUI). The aim of this study was to determine the prevalence of BUI and the associated risk factors in a representative Korean population. The data of 4,833 adult bicyclists who participated in the Korean National Health and Nutrition Examination Survey (2010-2012) were analyzed. Among the 4,833 participants investigated in this study, 586 (12.1%) had experienced BUI. As participants' age increased, so did the prevalence of BUI (P < 0.001), with the participants who were aged 60-69 showing the highest prevalence of BUI (19.6%). With regard to BUI and drinking habits, the likelihood of being a heavy or high-risk drinker increased with the frequency of BUI (P < 0.001). In addition, there was a positive relationship between the frequency of BUI and alcohol use disorder identification score level. Finally, those who had previous experiences of BUI were significantly more likely to drive and ride motorcycles under the influence (P < 0.001). In conclusion, the prevalence of BUI was 12.1% and several associated risk factors for BUI were elucidated in this study. The development of specific preventive strategies and educational programs aimed at deterring individuals at a high risk of engaging in BUI is expected to reduce the number of alcohol-related bicycle injuries.

DUI histories in intoxicated injured bicyclists

INTRODUCTION

It has been well documented that the use of alcohol correlates with injury risk, especially in DUI (driving under the influence) and DWI (driving while intoxicated). Consumption of alcohol in patients presenting with bicycle-related injuries is associated with greater injury severity, longer hospitalization, and higher health care costs. We hypothesized that intoxicated patients operating a bicycle with traumatic injuries have previous DUI or DWI convictions and had lost their privilege to drive a motor vehicle, resorted to bicycling, and had continued alcohol consumption despite negative previous consequences.

METHODS

We retrospectively collected data on injured bicyclists older than 18 years with positive blood alcohol content levels treated from the period January 2009 to June 2014 at a large Level 1 urban trauma center. We then matched each patient by name and date of birth and were able to obtain public criminal records through the Superior Court of California for the local of county.

RESULTS

A total of 149 injured bicyclists with positive blood alcohol levels were identified. Their average blood alcohol content was 236.0 mg/dL, and their average age was 41 years. Sixty-six (44.2%) of these patients had prior DUI/DWI convictions with suspension of driving privileges. Ninety-five patients in this group (63.8%) had no health insurance, and 51 patients (34.2%) tested positive for other drugs. Intoxicated bicyclists trended toward longer hospital length compared with nonintoxicated bicyclists (4.60 vs. 3.44 days; p = 0.07). Three (0.02%) of 149 patients were charged with bicycling while intoxicated.

CONCLUSION

Intoxicated bicyclists involved in trauma are more likely to have a previous DUI/DWI, have other drug use, tend to have longer hospital stays, and are less likely to have insurance. Bicycle safety education and behavior modification targeting DUI/DWI offenders are warranted. In order to promote injury prevention, resources to increase awareness of this underestimated public health issue should be promoted.

LEVEL OF EVIDENCE

Epidemiologic study, level III.

Alcohol use by urban bicyclists is associated with more severe injury, greater hospital resource use, and higher mortality

Alcohol use is a risk factor for severe injury in pedestrians struck by motor vehicles. Our objective was to investigate alcohol use by bicyclists and its effects on riding behaviors, medical management, injury severity, and mortality within a congested urban setting. A hospital-based, observational study of injured bicyclists presenting to a Level I regional trauma center in New York City was conducted. Data were collected prospectively from 2012 to 2014 by interviewing all bicyclists presenting within 24 h of injury and supplemented with medical record review. Variables included demographic characteristics, scene-related data, Glasgow Coma Scale (GCS), computed tomography (CT) scans, and clinical outcomes. Alcohol use at the time of injury was determined by history or blood alcohol level (BAL) >0.01 g/dL. Of 689 bicyclists, 585 (84.9%) were male with a mean age of 35.2. One hundred four (15.1%) bicyclists had consumed alcohol prior to injury. Alcohol use was inversely associated with helmet use (16.5% [9.9-25.1] vs. 43.2% [39.1-47.3]). Alcohol-consuming bicyclists were more likely to fall from their bicycles (42.0% [32.2-52.3] vs. 24.2% [20.8-27.9]) and less likely to be injured by collision with a motor vehicle (52.0% [41.7-62.1] vs. 67.5% [63.5-71.3]). 80% of alcohol-consuming bicyclists underwent CT imaging at presentation compared with 51.5% of non-users. Mortality was higher among injured bicyclists who had used alcohol (2.9% [0.6-8.2] vs. 0.0% [0.0-0.6]). Adjusted multivariable analysis revealed that alcohol use was independently associated with more severe injury (Adjusted Odds Ratio 2.27, p = 0.001, 95% Confidence Interval 1.40-3.68). Within a dense urban environment, alcohol use by bicyclists was associated with more severe injury, greater hospital resource use, and higher mortality. As bicycling continues to increase in popularity internationally, it is important to heighten awareness about the risks and consequences of bicycling while under the influence of alcohol.

Cycling-related crash risk and the role of cannabis and alcohol: a case-crossover study

OBJECTIVE

To examine whether alcohol and cannabis consumption increase crash risk among non-fatally injured bicyclists (N=393) seen in three Canadian emergency departments, between April 2009 and July 2011.

METHOD

Employing a case-crossover design, cannabis and alcohol were identified through blood sample or by self-report. All cyclists involved in a crash and exposure status (cannabis and alcohol) were compared between case period (current crash) and two control periods: prior to the last time the victim cycled around the same time of day; and the typical use prior to bicycling. Crash risk was assessed through conditional fixed effects logistic regression models.

RESULTS

Approximately 15% of cyclists reported using cannabis just prior to the crash, and 14.5% reported using alcohol. Cannabis use identified by blood testing or self-report in the case period and by self-report in the control period yielded a crash risk of 2.38 (1.04-5.43); however, when self-report was used for both the case and control periods the estimate was 0.40 (0.12-1.27). Alcohol use, as measure either in blood or self-report, was associated with an odds ratio of 4.00 (95% CI: 1.64-9.78); results were similar when alcohol was measured by self-report only.

CONCLUSION

Cannabis and alcohol use each appear to increase the risk of a non-fatal injury-related crash among bicyclists, and point to the need for improved efforts to deter substance use prior to cycling, with the help of regulation, increased education, and greater public awareness. However, cannabis results should be interpreted with caution, as the observed association with crash risk was contingent on how consumption was measured.

Ethanol, Trauma, and the Brain

Alcohol intoxication plays a significant and causal role in various fatal injuries. In comparison to sober individuals, intoxicated people have a greater generic risk for being involved in hazardous activities that may result in fatal injuries. However, it is not clear whether the biological effects of acute alcohol intoxication result in worse injuries than those sustained by sober individuals who are injured by identical mechanisms. Alcohol intoxication has a neuroprotective effect in experimental animal models of traumatic brain injury (TBI) but the evidence for a similar effect in humans is controversial. Earlier studies found such a protective effect, but more recent large epidemiological studies have not confirmed this finding; some studies also suggest a dose-related protective or exacerbating effect of alcohol intoxication on TBI. There are two apparent alcohol-associated syndromes in which an otherwise survivable blunt force impact to the head of an intoxicated individual is fatal at the scene. The first is a fatal cardiorespiratory arrest (the so-called alcohol concussion syndrome or “commotio medullaris”); the second is “traumatic basilar subarachnoid hemorrhage” (secondary to tears in the cerebral arteries, particularly the intracranial and extracranial vertebral arteries).

Alcohol consumption, helmet use and head trauma in cycling collisions in Germany

Cycling, being easy, inexpensive and healthy, is becoming one of the most popular means of transport. Cyclists, however, are among the most vulnerable road users in traffic collisions. The aims of this study were to establish which cyclist and cycling accident characteristics are associated with alcohol consumption and helmet use in Germany and to identify risk factors related to head trauma sustained in cycling accidents. The source used for the present analysis was the database of the German in-depth accident study (GIDAS). All cyclists who had been involved in a road accident between 2000 and 2010 and submitted to an alcohol test were selected. Logistic regression analyses were carried out to evaluate various aspects: alcohol consumption, helmet use, head trauma, and cyclist/accident characteristics. Female riders were less likely to have consumed alcohol (OR=0.23, 95% CI: 0.08-0.66); cyclists who did not wear a helmet were more likely to have consumed alcohol (OR=2.41, 95% CI: 1.08-5.38); cyclists who were not responsible for the collision were less likely to have consumed alcohol than those who were partially responsible for the accident (OR=0.22, 95% CI: 0.08-0.61). Cyclists involved in collisions with another vehicle, motorised or not, had a lower risk of suffering a head injury compared with those involved in single-vehicle accidents (OR=0.27, 95% CI: 0.12-0.62, and OR=0.08, 95% CI: 0.03-0.22, respectively). The prevention or limiting of alcohol consumption among cyclists and the corresponding testing of cyclists must be improved. Training initiatives on helmet protection should be encouraged.

Recreational helmet use as a predictor of noncranial injury

BACKGROUND

The effect of helmet use in the prevention of head injury has been clearly shown. However, the relationship between helmet compliance and other bodily (noncranial) injury has not been explored, yet may have important impact on strategies for injury prevention. The purpose of this study was to examine helmet use in an injured population to evaluate its association with noncranial trauma.

METHODS

All entries in the Canadian National Trauma Registry were surveyed from 2000 to 2004 and limited to injuries sustained in recreational sports associated with helmet use.

RESULTS

Over the 5-year period, 2,205 injuries met inclusion criteria. Cycling-related injuries were most frequent (43.5%). Alcohol consumption correlated significantly with lack of helmet use. Nonhelmeted individuals suffered significantly more noncranial injuries (85% vs. 68%, p < 0.0001) and had twice as many severe head injuries (Glasgow Coma Scale score ≤ 8) (odds ratio [OR]: 2.13, 95% confidence interval [CI]: 1.35-3.37) or any abnormal Glasgow Coma Scale score (OR: 1.96, 95% CI: 1.55-2.47). While controlling for age, sex, or type of sport activity performed, multivariate regression confirmed a reduction in associated noncranial injuries when helmets were used (OR: 0.86, 95% CI: 0.83-0.89).

CONCLUSIONS

Within an injured population from sports-related activities, helmet use is associated with fewer noncranial injuries of all types suggesting reduced overall risk of injury in this group. In addition, use of helmets is associated with less frequent and less severe head injury. Alcohol consumption is related to increased risk of injury and is more prevalent in injured individuals who abstain from helmet use.

LEVEL OF EVIDENCE

III, prognostic study.

Brewing complications: the effect of acute ethanol exposure on wound healing

Ethanol consumption is linked to a higher incidence of traumatic wounds and increases the risk for morbidity and mortality following surgical or traumatic injury. One of the most profound effects of acute ethanol exposure on wound healing occurs during the inflammatory response, and altered cytokine production is a primary component. Acute ethanol exposure also impairs the proliferative response during healing, causing delays in epithelial coverage, collagen synthesis, and blood vessel regrowth. The accumulated data support the paradigm that acute ethanol intoxication prior to injury significantly diminishes a patient's ability to heal efficiently.

Road traffic mortality in Estonia: Alcohol as the main contributing factor

Traffic fatalities are the leading cause of death among the young and middle-aged population in Estonia. The objective of this study was to reveal the pattern of traffic fatalities among the population aged 15 - 64 years and to determine the role of alcohol in their fatalities. The data were collected from post-mortem reports at the Estonian Bureau of Forensic Medicine from 2000 to 2002. Alcohol-related deaths were those with a blood alcohol concentration (BAC) equal or above 0.05 g/100 ml. Out of 512 victims, 401 were males and 111 were females. The greatest group were car occupants (58%) followed by pedestrians (31%). The portion of alcohol-related deaths was 70% among men and 44% among women. The mean BAC and percentage of alcohol-related deaths was significantly higher in pedestrian than in driver fatalities. Alcohol intoxication was identified as the most powerful contributing factor to traffic fatalities. The results provide more evidence for politicians to tackle alcohol abuse and unsafe traffic environments.

Pattern of drinking and fatal injury: a population-based follow-up study of Finnish men

AIM

To find out how the frequency of drinking one to two drinks, three to four drinks and five or more drinks of alcohol per drinking occasion predicts injury mortality in 16 years of follow-up among the Finnish 15-69-year-old male population.

DESIGN

Three alcohol surveys conducted in 1969, 1976 and 1984 were pooled and linked with mortality information from the national cause of death register.

METHOD

Cox proportional hazard models were used for analysing the survival time data.

FINDINGS

Drinking at the level of one to two drinks, regardless of frequency, did not elevate the risk of fatal injury, nor did drinking at the level of three to four drinks. Drinking five or more drinks at a time significantly increased the risk of fatal injury in graded relation, compared with those who never drank at that level. The risk was highest for those who drank five or more drinks at a time at least weekly (RR = 5.78, 95% CI = 2.80-11.94), when adjusted for possible confounders.

CONCLUSIONS

We found that besides the total volume of consumption, a drinking pattern that involves drinking occasions when consumption exceeds four drinks of alcohol at a time leads to a significant increase in the risk of fatal injury among Finnish men. The risk is highest among those who have the highest annual number of heavy drinking occasions. The finding does not support the hypothesis that alcohol tolerance would lower the risk of fatal injuries among frequent heavy drinkers.

Epidemiology and outcome of bicycle injuries presenting to an emergency department in the United Kingdom

OBJECTIVES

To describe the epidemiology, injuries sustained and outcomes of patients presenting to an emergency department after a bicycle accident in Cambridge, England.

METHODS

A prospective study was conducted of all individuals treated as a result of a cycling accident between 1 April 2003 and 31 July 2003. Information was collected from injured cyclists or relatives by a standardized questionnaire. This included patient demographics, details relating to the accident, and injuries sustained.

RESULTS

A total of 293 injured cyclists presented during the study period. The most commonly injured were men (65.5%) in isolated bicycle accidents on roads without cycle paths during daylight hours. Only 20.8% of patients wore helmets. The majority of those injured at night (62.5%) had consumed alcohol (P<0.05). Upper limb injuries were most frequently sustained (64%), with an even distribution of lower limb (24%), head (23%) and facial (22%) injuries. Truncal and neck injuries were uncommon.

CONCLUSIONS

Although it is recognized that the use of bicycle helmets contributes to a decrease in mortality from head injuries, this should not be the only focus for decreasing the morbidity associated with cycling accidents. Campaigns for safer cycling practice, more dedicated cycle routes and to discourage cyclists from drinking and cycling are essential to decrease the numbers of these injuries.

Acute ethanol exposure impairs angiogenesis and the proliferative phase of wound healing

Acute ethanol exposure represents an increased risk factor for morbidity and mortality associated with surgical or traumatic injury. Despite clinical observations suggesting that ethanol exposure before injury alters tissue repair processes, little direct evidence about the mechanism by which ethanol affects the wound healing process is available. In this study, excisional wounds from female BALB/c mice with or without circulating ethanol levels of 100 mg/dl were used to assess wound closure, angiogenesis, and collagen content. Ethanol exposure resulted in a significant but transient delay in wound closure at day 2 postwounding (28 +/- 4% vs. 17 +/- 1%). In addition, total collagen content was significantly reduced by up to 37% in wounds from ethanol-treated mice compared with controls. The most significant effect of ethanol exposure on wounds was on vascularity because angiogenesis was reduced by up to 61% in wounds from ethanol-treated mice. The reduction in vessel density occurred despite near-normal levels of proangiogenic factors VEGF and FGF-2, suggesting a direct effect of ethanol exposure on endothelial cell function. Further evidence for a direct effect was observed in an in vitro angiogenesis assay because the exposure of endothelial cells to ethanol reduced angiogenic responsiveness to just 8.33% of control in a cord-forming assay. These studies provide novel information regarding the effect of a single dose of ethanol on multiple parameters of the wound healing process in vivo and suggest a potential mechanism by which ethanol impairs healing after traumatic injury.

Characteristics of alcohol-related fatal general aviation crashes

BACKGROUND

The effects of alcohol on piloting performance have been studied extensively. Information describing alcohol-related aviation crashes, however, is scant.

METHODS

We developed a data system for fatally injured pilots in Maryland, New Mexico, and North Carolina by linking autopsy data from the state medical examiner offices and crash investigation reports from the National Transportation Safety Board. Alcohol-related crashes are defined as those in which the pilot had a blood alcohol concentration of 20 mg/dL or greater. Differences between alcohol- and non-alcohol-related crashes were assessed with regard to pilot characteristics, crash circumstances, and human factors.

RESULTS

The National Transportation Safety Board recorded 313 general aviation crashes fatal to the pilot in the three states between 1985 and 2000. Of these crashes, 255 (81%) were matched successfully with medical examiner records. Alcohol testing results were available for 233 of the fatally injured pilots. Of those tested for alcohol, 25 (11%) had blood alcohol concentrations > or =20 mg/dL (mean=75 +/- 64 mg/dL). The majority of alcohol-related crashes (52%) occurred at night (7p.m. to 6a.m.), compared with 28% of other crashes (P < 0.01). Alcohol-related crashes were significantly more likely than other crashes to have involved continued flight under visual flight rules (VFR) into instrument meteorological conditions (IMC) (32% versus 12%, P < 0.01), and flawed decisions (64% versus 41%, P = 0.03).

CONCLUSIONS

Distinctive epidemiological patterns are exhibited in alcohol-related fatal general aviation crashes. Alcohol appears to play a particularly important role in crashes involving flight under VFR into IMC.

Psychological aspects of traumatic injury in children and adolescents

Each year millions of children are exposed to some form of extreme traumatic stressor. These traumatic events include natural disasters (e.g., tornadoes, floods, hurricanes), motor vehicle accidents, life-threatening illnesses and associated painful medical procedures (e.g., severe burns, cancer, limb amputations), physical abuse, sexual assault, witnessing domestic or community violence, kidnapping, and sudden death of a parent. During times of war, violent and nonviolent trauma (e.g., lack of fuel and food) may have terrible effects on children's adjustment. The events of September 11, 2001 and the unceasing suicidal attacks in the Middle East underscore the importance of understanding how children and adolescents react to disasters and terrorism. The body of literature related to children and their responses to disasters and trauma is growing. Mental health professionals are increasing their understanding about what factors are associated with increased risk (vulnerability) and affect how children cope with traumatic events. Researchers recognize that children's responses to major stress are similar to adults' (reexperiencing the event, avoidance, and arousal) and that these responses are not transient. A review of the literature indicates that PTSD is the most common psychiatric disorder after traumatic experiences, including physical injuries. There is also evidence for other comorbid conditions, including mood, anxiety, sleep, conduct, learning, and attention problems. In terms of providing treatment, CBT emerges as the best validated therapeutic approach for children and adolescents who experienced trauma-related symptoms, particularly symptoms associated with anxiety or mood disorders. The best approach to the injured child requires injury and pain assessment followed by specific interventions, such as pain management, brief consultation, and crisis intervention immediately after the specific traumatic event. Family support also may be necessary to help the family through this difficult period. The main conclusion that arises from the research on resilience in development is that extraordinary resilience and recovery power of children depend on basic human protective systems operating in their favor. This finding has produced a fundamental change in the framework for understanding and helping children at high risk or already in trouble. This shift is evident in a changing conceptualization of the goals of prevention and intervention that currently address competence and problems. Strategies for fostering resilience described in this article should be tested in future controlled psychotherapy trials to verify their efficacy on children's protective factors.

Cycling and alcohol

PURPOSE

To compare the accident and the psychosocial circumstances and the consequences of the injuries sustained by intoxicated (alcohol) and sober cyclists in road traffic accidents.

MATERIAL AND METHODS

A telephone interview was conducted with 207 adults injured 3 years earlier. The group was selected from the list of 1278 cyclists registered at the hospitals in Göteborg in 1995 and 1996. Ninety-five of the 207 had been registered as under the influence of alcohol and 112, registered as sober, constituted a matched group.

RESULTS

Compared with the sober group, the intoxicated cyclists more often sustained their injuries at night time (P<0.001), at the weekend (P<0.001), on their way to or from a party or a pub/restaurant (P<0.001) and in single accidents (P<0.001) with a greater risk of injury to the head or face (P<0.001). They cycled less during the year (P<0.001), were not so familiar with the route (P=0.045) or bicycle (P<0.001), had bicycles without a hand-brake or gears (P=0.045) and less often wore a helmet (P=0.003). Driving licences had been revoked only in the intoxicated group (P=0.02) and nine out of ten who were divorced were from this group (P=0.004).

CONCLUSIONS

Injury prevention for cyclists should aim at altering the attitude towards cycling intoxicated and increasing the use of a helmet. The alternative is a change in the law in both cases.

Ten-year research review of physical injuries

OBJECTIVE

To review the past 10 years of research relevant to psychiatry on injuries in children and adolescents.

METHOD

A literature search of databases for "wounds and injuries, excluding head injuries," was done with Medline and PsycINFO, yielding 589 and 299 citations, respectively. Further searching identified additional studies.

RESULTS

Progress is occurring in prevention, pain management, acute care, psychiatric treatment, and outcomes. The emotional and behavioral effects of injuries contribute to morbidity and mortality. Psychiatric assessment, crisis intervention, psychotherapy, psychopharmacological treatment, and interventions for families are now priorities. Research offers new interventions for pain, delirium, posttraumatic stress disorder, depression, prior maltreatment, substance abuse, disruptive behavior, and end-of-life care. High-risk subgroups are infants, adolescents, maltreated children, suicide attempters, and substance abusers. Staff training improves quality of care and reduces staff stress.

CONCLUSIONS

Despite the high priority that injuries receive in pediatric research and treatment, psychiatric aspects are neglected. There is a need for assessment and for planning of psychotherapeutic, psychopharmacological, and multimodal treatments, based on severity of injury, comorbid psychopathology, bodily location(s), and prognosis. Psychiatric collaboration with emergency, trauma, and rehabilitation teams enhances medical care. Research should focus on alleviating pain, early psychiatric case identification, and treatment of children, adolescents, and their families, to prevent further injuries and reduce disability.

Social services referral of adolescent trauma patients admitted following alcohol-related injury

Alcohol screening of severely injured patients should be universal. Hospitalization following alcohol-related injury provides an opportunity for intervention to reduce recidivism. This study examines the frequency of social services referral of an alcohol positive cohort of adolescent trauma patients. This was a retrospective analysis of data collected from 1994 through 1998 by the National Pediatric Trauma Registry. All patients between the ages of 12 and 17 who had a blood alcohol level (BAL) measured were analyzed. Patients receiving referral to the department of social services, family counseling, or addiction services, and those receiving any substance abuse education intervention were considered a positive referral. There were 6006 children age 12 to 17 included in the database during this five-year period, 751 of whom had a BAL measured. Of those screened, 15.5% were positive. Sixty-eight (59%) of the BAL positive patients were referred for intervention through social services. The only statistically significant predictor of referral was whether or not the patient was the operator of a vehicle involved in the motor vehicle collision. Nearly half of the adolescents in this study, who screened positive for alcohol, received no social services support.

Alcohol and injury in adolescents

OBJECTIVE

To determine the frequency of alcohol ingestion in adolescent victims of major trauma and determine whether alcohol ingestion is associated with increased injury severity or death.

METHODS

Subjects were all patients between 12-25 years of age treated at Pennsylvania trauma centers in 1996 who were reported to the state trauma database. Data on age, mechanism of injury (E-code), blood alcohol concentration (BAC), Injury Severity Score (ISS), and survival were obtained from the state database. BAC positive and negative patients within three groups: ages 12-17, 18-20, and 21-25, were compared to determine any difference in death rate, injury severity or type of injury.

RESULTS

4309 patients aged 12-25 were reported to the state in 1996. 2724 (63.2%) underwent testing for BAC, with 884 (32.5%) of those tested being positive. Testing positive were: 93/726 (12.8%) between 12-17 years old, 249/844 (29.5%) between 18-20 years old, and 542/1154 (47.0%) between 21-25 years old. 567/884 (64.1%) of those testing positive had BAC > or = 100 mg/dl. There were no statistically significant differences in mean ISS or death rate between BAC negative and BAC positive patients in either of the age groups. Regression analysis also showed no relationship between mortality and either the presence of alcohol or the actual level of BAC. Other regression analysis demonstrated a slight downward trend for ISS with increasing intoxication, which was statistically significant at P < 0.01.

CONCLUSIONS

Alcohol ingestion is found even in early adolescent trauma patients and is seen to increase throughout the teenage years, occurring in over one-quarter of patients 18 to 20 years of age. Suspicion must be high that ingestion of alcohol has occurred in adolescent trauma. Further efforts should be made to improve the rate of testing in late adolescents, to ensure adequate identification of all alcohol-exposed patients and enable educational interventions. No significant differences in mortality were seen between alcohol positive and negative patients, but there was a trend to decreased injury severity with the presence of alcohol.

Alcohol use in relation to driving records among injured bicyclists

To prevent alcohol-related occupational mishaps, employers often conduct background checks on prospective employees for history of driving while intoxicated (DWI) and driving under the influence of alcohol (DUI) to screen out candidates with drinking problems. Few studies, however, have examined the pervasive nature of drinking behavior across activity domains. Based on trauma registry data, we constructed a historical cohort of 120 Maryland residents ages 18 years or older who were injured while riding a bicycle between 1990 and 1997. Driving records for the 120 bicyclists for the 3 years between May 6, 1995 and May 5, 1998 were obtained from the state motor vehicle administration and were analyzed in relation to BAC-positive status at the time of injury. Bicyclists with positive BACs at the time of admission to the trauma center were significantly more likely than those with negative BACs to have a record of license suspension/revocation (52% vs 14%, P < 0.01) and to have DWI/DUI convictions (30% vs 3%, P < 0.01). Despite the modest sample size, this study provides compelling evidence of the pervasive nature of risky drinking between bicycling and driving activities.

Base deficit level indicating major injury is increased with ethanol

Analyses were performed to determine whether ethanol increases base deficit, independent of major injury, in blunt trauma patients from two Level I trauma centers. In 2140 Baltimore patients, base deficit was significantly higher in ethanol-positive patients (blood level > or =0.01%), independent of blood pressure (BP), Injury Severity Score (ISS), and blood loss. In 139 Youngstown, Ohio, patients, base deficit was significantly higher in ethanol-positive patients, independent of ISS and RBC units given. In 1796 awake Baltimore patients, major injury was defined as an ISS >10, presence of blood loss, or need for RBC transfusion. A base deficit < or =-4.1 for ethanol-positive and < or =-1.1 for ethanol-negative patients had higher rates of major injury (odds ratio 3.2 and 2.1, respectively) and abdominal trauma (odds ratio 3.6 and 3.2, respectively). In blunt trauma patients, base deficit is increased with ethanol, independent of major injury. A base deficit of < or =-4.1 for ethanol-positive and < or =-1.1 for ethanol-negative awake patients may be an early warning for occult injury and suggest the need for an abdominal computed tomography (CT) scan or ultrasound.

Alcohol usage in sport and exercise

In this review we consider some of the acute and chronic effects of alcohol on human exercise and sport performance. The 1982 position stand of the American College of Sport Medicine on the use of alcohol in sport emphasized that there was little benefit for an athlete. Subsequent literature continues to demonstrate that there are adverse effects on performance. However, the literature is often confusing and disparate. We will attempt to explain the effects and speculate on the possible mechanisms. We divide the review into acute and chronic metabolic and physiological effects of alcohol on exercise performance, primarily in humans. We also review the epidemiological evidence of the associations between alcohol use and problem alcohol behaviors in various athletic groups. Finally, we review the limited data on the effectiveness of exercise therapy in the treatment of alcohol dependent patients. In spite of scientific evidence that alcohol use is, in general, detrimental (or of no benefit) to sport (exercise) performance, alcohol continues to be used by athletes both on a chronic basis and even immediately prior to sports participation. There is some encouraging but limited evidence that student-athlete alcohol use is decreasing and exercise can be effective as part of alcohol rehabilitation.